h  Regards  of  the  Author, 


LIBRARY 

OF  THE 

NIVERSITY  of  ILLINOIS, 


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SUPPLEMENTAL  REPORT 


ON 


STATE  MEDICINE,  HYGIENE,  ETC. 

Read  before  the  Medical  Society  of  the  State  of  California,  at*  it* 
Annual  Meeting,  held  in  San  Francisco,  in  April,  1892, 

 BY  


M.  M.  CHIPMAN,  M,  D. 


MEMBER  OF  THE 

San  Francisco  County  Medical  Society, 

Medical  Society  of  the  State  of  California 

American  Medical  Association, 

AUTHOR  OF 

REPORTS  ON  MINING  DEBRIS  DEPOSITS,  FOREST  PRESERVATION  AND 
TIMBER  CULTIVATION,  PUBLIC  HYGIENE  AND  STATE  MEDICINE,  MICRO- 
ORGANISMS AND  THEIR  RELATION  TO  HUMAN  AND  ANIMAL  LIFE* 
AND  OTHER  REPORTS  AND  PAPERS,  WRITTEN  AND  RENDERED 
AS  A  MEMBER  OF  OR  AS  CHAIRMAN  OF  DIFFERENT  COM- 
MITTEES, AT  THE  SEVERAL  INSTANCES,  OF  THE  STATE 
MEDICAL  SOCIETY,  AND  RE-PRINTED  FROM  ITS 
VOLUMES  OF  TRANSACTIONS. 


jifooilfik^ 


llillijl 


iqOt 
X    'V    X  \ 


W.  A.  Woodward  &  Co ,  Printers,  12  Sutter  street,  San  Francisco 


SUPPLEMENTAL  REPORT 

ON 

STATE  MEDICINE,  HYGIENE,  ETC. 

By  M.  M.  CHIPMAN,  M.  D.,  San  Jose. 


Mr.  President  and  Members  of  the  State  Medical  Society: 

Of  the  numerous  species  of  microbes  which  infest  the  animal 
life  and  the  bodies  and  habitations  of  men,  but  do  not  attack 
the  living  tissues  of  the  body,  the  works  on  bacteriology  give 
no  definite  description  of  their  manner  of  subsistence;  but  as 
some  of  the  experimenters  have  found  that  many  species  feed 
on  combinations  of  carbon,  it  is  evident  that  the  carbon  which 
issues  with  the  expired  breath  and  from  the  external  sweat  pores, 
furnishes,  largely,  the  pabulum;  and  the  hair,  wool  and  feathers 
of  animals  and  of  birds  and  the  clothing  of  the  human  being 
furnish  the  shelter  and  warmth  required  for  their  development 
and  multiplication;  and  in  human  habitations  the  artificial  heat, 
required  during  the  cooler  season,  provides  supplemental  means 
of  comfort  and  perpetuation  to  these  external  parasites.  The 
animal  life  is,  more  or  less,  tolerant  of  the  non-malignant 
microbes.    Their  relations  to  the  human  being  might  be  com- 
pared to  that  of  weeds  to  the  trees  of  an  orchard;  the  cleaner 
the  ground  is  kept  of  the  weeds,  the  better  the  trees  thrive  and 
the  more  abundant  and  better  the  quality  of  the  fruit,  and  the 
less  the  liability  to  disease ;  but  if  the  ground  be  made  perfectly 
free  of  weeds  it  yet  always  contains  the  seed  which  will  send 
forth  another  crop;  and  so  with  the  animal  and  especially  with 
more  susceptible  man,  however  clean,  however  free  from  exter- 
nal parasites  he  may  make  himself,  there  is  always  enough  of 
germ  life  remaining  in  his  clothing,  on  the  furniture,  the  walls 
and  ceilings  of  the  house  and  in  the  atmosphere,  within  and 
without,  to  repopulate  his  person  and  his  dwelling  within  a  few 
hours;  and  thus  it  is  that  we  are  obliged  to  continuously  fight 
these  dependents  lest  the  creatures  which  feed  upon  the  excre- 
mentitious  substances  of  the  food,  which  has  already  served  as 
our  nutriment,  and  impose  themselves  upon  our  persons,  against 
our  wishes,  shall  become  over-dominant.    It  is  not  alone  in  the 
active  life  of  these  minute  organisms  that  they  annoy  us,  but 


/ 
j 


2      Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 

also  by  their  remains  after  death;  their  life  period  being  brief 
and  at  the  close  of  which,  the  lifeless  bodies  are  left  on  the  ani- 
mal or  person  whom  they  inhabited;  and  he  who  too  long  neglects 
bathing  will  thus  become  encrusted  over  to  the  diminishment  of 
the  perspiratory  function. 

As  ordinary  methods  of  ventilation  leave  places  in  the  rooms 
of  dwelling  houses  which  the  fresh  air  does  not  reach,  I  would 
suggest  that,  in  the  construction  of  houses,  all  the  apartments 
should  be  provided  with  ventilating  spaces,  both  at  the  top  and 
bottom  of  the  rooms,  with  swinging  or  sliding  doors,  something 
after  the  manner  of  the  ventilation  of  passenger  cars,  and  these 
little  doors  should  be  opened  for  awhile  every  day,  preferably, 
whilst  cool,  in  the  morning;  and  thus,  with  the  sweeping  of  the 
floor  and  the  dusting  of  the  furniture,  the  fresh  outside  air 
would  sweep  the  air  of  the  room  as  well,  and  the  invisible  pop- 
ulation of  the  apartment  would  be  reduced  to  a  minimum;  and 
with  so  light  a  seeding  the  repopulation  would  not  become  dense 
again  during  the  succeeding  twenty-four  hours. 

Heavy  woolen  carpets  are  a  complete  refuge  for  microbes 
and  their  use  should  be  discontinued,  especially  during  the 
warmer  months;  and  to  compensate  for  the  wool  carpets,  cloth 
or  felt  slippers  might  be  worn  in  the  rooms  if  required. 

There  is  nothing  of  greater  use  or  utility,  in  proportion  to  the 
trouble  and  expense  involved,  than  the  sterilization  of  water  by 
boiling,  both  in  medical  and  surgical  practice;  and  for  drinking, 
when  necessary.  As  to  the  time  required  to  sterilize :— in  ordi- 
nary drinking  water  the  microbic  life  will  become  nearly  extinct 
against  it  has  been  brought  to  the  point  of  ebullition,  but  it  is 
safer  to  continue  the  boiling  for  two  or  three  minutes,  if  to  be 
used  immediately;  but  if  to  be  kept  for  a  day  or  more,  it 
should  be  boiled  for  twice  that  length  of  time:  and  if  heavily 
charged  with  microbic  life,  especially  if  the  presence  of  malig- 
nant bacteria  is  suspected,  the  boiling  should  be  still  prolonged 
to  perhaps  ten  minutes.    Boiled  water  becomes  reinfected  if 
exposed  to  the  air  on  cooling  very  rapidly.    Tyndall,  in  his 
experiments,  found  that  his  infusions,  on  removal  from  the  heat- 
ing flame,  became  reinfected  within  the  space  of  two  minutes,  if 
exposed;  and  water,  if  not  to  be  used  immediately,  should  either 
be  boiled  in  a  water  bath,  in  closed  vessels,  or  stoppered  before 
ebullition  ceases,  and  the  stoppers  not  removed  until  thej  mo- 
ment of  using. 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc.  3 

Pasteur  states  that  it  requires  a  temperature  of,  at  least,  110 
degrees  Centigrade,  equal  to  230  Fahrenheit,  to  effectively  steril- 
ize milk;  but  Pasteur  intended  the  milk  to  be  so  completely- 
sterilized  that  it  could  be  kept  in  air-tight  vessels  for  an  indefin- 
ite period  without  developing  organic  life .  Two  vessels  or  bot- 
tles, containing  milk  of  equal  freshness,  might  be  kept  exposed 
to  the  same  degree  of  heat  for  the  same  length  of  time  and  the 
milk  in  one  of  the  bottles  might  be  so  thoroughly  sterilized  that 
it  would  keep  indefinitely,  whilst  in  the  other  organic  life  might 
develop  in  the  course  of  a  week  or  more;  the  difference  in  the 
conduct  of  the  two  samples,  arising  from  the  circumstance,  that 
the  milk  of  the  infected  sample  had  been  exposed  to  the  intro- 
duction, before  the  heating,  either  of  niore  persistent  species 
than  the  other,  or  that  it  had  received  germs  which  had  been 
more  thoroughly  dessicated,  and,  therefore,  required  a  longer 
exposure  to  heat,  in  order  to  destroy  them.  I  have  no  doubt 
that  much  benefit  has  been  derived  from  the  ordinary  scalding 
of  milk,  as  it  is  termed,  as  the  greater  part  of  germ  life  will  be 
destroyed  by  the  exposure  to  two  hundred  and  twelve  degrees 
Fahrenheit;  and  by  long  enough  subjection,  at  the  boiling  point 
of  water,  milk  will  become  thoroughly  sterilized;  and  as  it  is 
liable  to  be  injured,  in  quality,  by  exposure  to  too  great  heat, 
the  water-bath  is  a  safeguard,  in  that  respect;  but  I  would 
recommend  that  the  water,  in  which  the  bottles  are  immersed, 
should  be  kept  in  ebullition  for  at  least  ten  minutes,  in  case  the 
milk  is  for  immediate  use,  and  for  a  longer  time,  if  to  be  kept 
for  a  day  or  two.  Some  of  the  dairies  of  all  cities,  should  pro- 
vide themselves  with  apparatus  for  sterilizing  milk  by  heat,  to 
deliver  in  bottles,  or  closed  vessels,  to  such  customers  as  would 
prefer  it  in  that  form,  which  would  be  a  great  convenience  and 
beneficial  to  many  families,  and  could  be  made  remunerative  to 
those  engaged  in  the  business. 

The  external  micro-organisms,  those  which  do  not  directly 
attack  the  human  organism,  cause  us  a  great  deal  of  trouble, 
and  oblige  us  to  exercise  constant  care  and  watchfulness;  yet 
with  such  care  and  vigilance,  we  are  able  to  hold  our  own 
against  them;  but  the  more  malignant  species,  those  which  have 
the  capacity  to  attack  the  living  tissues,  are  our  dread;  and 
they,  together  with  those  which  colonize  in  the  partially  digested 
contents  of  the  alimentary  canal,  cause  us  alarm  whenever  their 
presence  becomes  known;  and  against  these  we  are  obliged  to 


4       Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 

wage  a  war  of  extermination;  but,  fortunately,  the  very  condi- 
tions of  their  subsistence  render  them  unable  to  extensively 
pervade  the  air,  water  and  soil,  as  do  the  comparatively  harm- 
less microbes,  and  this  limitation  enables  us,  with  the  knowl- 
edge acquired  by  the  study  of  their  habits,  to  prosecute  the  war 
with  some  degree  of  success.  As  to  the  manner  of  the  introduc- 
tion of  pathogenic  microbes  into  the  human  system,  that  is  a 
question  which  has  not  yet  been  definitely  settled,  in  all 
respects.    In  every  act  of  respiration,  it  might  naturally  be 
supposed,  that  we  are  liable  to  infection,  provided  germs  of  a 
malignant  species  are  present;  but  nature  has  provided  protec- 
tion against  such  constant  exposure,  in  the  complicated  struct- 
ure of  the  lungs,  by  wtiich  the  air  is  filtered  of  its  germs  as  it 
is  inhaled.    Professor  Lister  first  pointed  out,  that  air,  which 
has  passed  through  the  lungs,  has  lost  its  power  of  producing 
putrefaction;  and  Tyndall,  by  a  series  of  experiments,  ascer- 
tained that,  in  the  act  of  expiration,  the  last  of  the  air  expired 
had  been  purified  of  its  germs.    But  whilst  I  do  not  consider 
that  such  experiments  have  been  carried  to  the  extent  to  justify 
the  statement,  as  an  ascertained  fact,  that  living  germs  never 
enter  the  body  through  the  lungs,  yet  there  is  evidence  enough 
to  confirm  the  position,  that  such  entrance  is  rare,  if  it  ever 
occurs;  whilst  on  the  other  hand,  there  is  no  obstacle  to  en- 
trance by  the  mouth  and  alimentary  canal,  with  the  food  and 
beverages;  and,  therefore,  except  such  infection  as  may  be 
introduced  by  the  means  of  external  wounds,  punctures  or 
abrasions  and  the  specially  exposed  mucous  surfaces,  the  hurtful 
micro-organisms,  if  not  exclusively,  must  principally  obtain 
entrance  by  the  way  of  the  oral  cavity.    And  having  gained 
admission,  the  obscure,  pernicious  visitant  is  carried  forward, 
with  the  food  and  fluids,  which  minister  to  the  animal  life,  into 
the  alimentary  canal,  and  perhaps  on  through  other  conduits, 
until  a  location  is  reached,  wherein  abound  the  special  resour- 
ces adapted  to  its  nutrition  and  development,  and  there  pro- 
ceeds to  appropriate,  to  colonize  and  multiply.    The  micrococ- 
cus of  diphtheria  travels  but  a  short  distance,  locating  on  the 
tonsils  and  in  the  throat,  where  it  initiates  its  poisonous  pro- 
cesses; the  newly  discovered  bacillus  of  influenza  first  puts  its 
grip  on  the  throat  and  bronchial  passages;  the  comma  bacillus 
glides  smoothly  along  with  the  ingested  food,  until  having 
passed  below  where  the  greater  part  of  the  digestive  solvents 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc,  5 

have  been  poured  in  upon  it,  and  the  process  of  digestion  has 
become  pretty  well  advanced,  when  the  microbe  finds  that  the 
changes  wrought  in  its  vehicle  of  entrance  has  converted  the 
semi-fluid  mass  into  a  culture  medium,  just  suited  to  its  use;  the 
bacillus  of  typhoid  fever  finds  its  special  nutriment  in  the  glands 
of  the  small  intestine;  the  pneumococcus  and  the  bacillus  of 
tubercle  are  developed  most  readily  in  the  aerobic  conditions 
and  tissues  of  the  lungs;  whilst  the  germs  which  originate 
small-pox  and  other  papular  and  eruptive  diseases  are  evidently 
absorbed  from  the  canal,  and  thence  carried  through  the  circu- 
lation to  near  the  surface,  before  they  find  the  conditions  of 
shelter  from  the  greater  blood  currents  and  the  character  of 
tissues  adapted  to  their  colonization.  But  not  all  microbes  are 
so  limited,  as  to  choice  of  location,  but  are  ready  to  commence 
work  with  the  first  opportunity  of  entrance  to  the  body;  as  ty- 
pical of  those  with  less  fastidiousness  of  conditions,  I  will  men- 
tion the  micrococcus  of  erysipelas  and  the  microbe  of  syphilis, 
both  of  which  usually  obtain  entrance  through  the  external 
surfaces,  although  unlike  otherwise  in  their  habits  and  processes 
of  working. 

In  a  recent  edition  of  a  standard  work  on  syphilis,  an  old, 
but  now  manifest,  error  is  perpetuated  in  the  statement,  in 
regard  to  the  incubation,  that,  "  after  the  poison  of  syphilis  has 
been  absorbed,  it  ferments,  as  it  were,  in  the  blood,  until  it  is 
ready  to  give  itself  local  expression."  To  see  the  incorrectness 
of  this  statement,  we  have  only  to  consider  certain  anatomical 
and  physiological  facts  and  the  evidences  in  regard  to  it.  The 
arteries,  capillaries  and  veins  form  one  continuous  system, 
through  which  the  blood  is  impelled  by  the  heart's  action, 
favored  by  the  elastic  structure  of  the  blood  vessels,  at  a  rate,  as 
found  by  the  experiments  of  Vierordt,  by  which  some  part  of 
it  makes  the  circuit  of  the  body,  during  each  period  of  twenty- 
seven  pulse  beats,  in  the  average  person  equal  to  thirty-two  and 
two-tenths  seconds  of  time,  and  although  such  portion  of  the 
blood  as  performs  the  greater  circuit  of  the  extremities,  and  that 
which  is  sent  off  to  perform  its  functions  in  the  liver,  kidneys 
and  other  glandular  organs,  is  somewhat  delayed  in  the  return, 
yet  it  all  obeys  the  progressive  impulse  and  keeps  moving  on. 
Now,  as  the  virus  of  syphilis,  as  we  have  every  reason  to  be- 
lieve, consists  of  microbes  or  microbic  germs,  and  as  all  organic 
fermentations  are  the  results  of  the  working  in,  the  changes  in 


6        Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 

the  substance,  wrought  by  the  microbes,  and  as  micro-organisms 
require  conditions  of  rest,  in  order  to  develop  and  multiply,  the 
continual  motion  of  the  blood,  subject  to  a  considerable  degree 
of  pressure  in  the  heart  and  the  arteries,  with  the  aeration  it  is 
subject  to  in  the  lungs,  and  the  straining  process,  as  it  were,  in 
the  capillaries  and  in  the  glands,  where  the  globules  pass  only 
in  small  companies,  or  in  single  file,  must  all  be  unfavorable  to, 
and  protective  as  against,  the  process  of  fermentation.  Then 
again,  it  has  been  ascertained  by  direct  experiments,  that  the 
composition  of  the  living  blood  is  highly  antiseptic. 

Dr.  Sternberg  states  that,  "  If  we  add  a  quantity  of  a  cult- 
ure fluid  containing  the  bacteria  of  putrefaction  to  the  blood 
of  an  animal,  withdrawn  from  circulation  into  a  proper  recep- 
tacle, and  maintained  in  a  culture  oven  at  blood  heat,  we 
will  find  that  the  bacteria  multiply  abundantly,  and  evidence 
of  putrefactive  decomposition  will  soon  be  perceived.  But 
if  we  inject  a  like  quantity  of  the  culture  fluid  with  its  con- 
taining bacteria  into  the  circulation  of  a  living  animal,  not 
only  does  no  increase  and  putrefactive  change  occur,  but  the 
bacteria,  introduced,  quickly  disappear,  and  at  the  end  of  an 
hour  or  two  the  most  careful  microscopical  observation  will  not 
reveal  the  presence  of  a  single  bacterium.    This  difference  we 
ascribe  to  the  vital  properties  of  the  fluid,  as  contained  in  the 
vessels  of  the  living  aminal."    Lewis   and  Cunningham,  in 
experiments  upon  quite  a  number  of  animals,  found  that  bacte- 
ria which  were  injected  into  the  circulation,  had  disappeared 
from  the  blood  of  nearly  one-half  of  the  animals  at  the  end  of 
twenty-four  hours;  and  of  thirty  animals  treated,  bacteria  were 
found  in  only  two,  when  the  examinations  were  made  within 
seven  days  after  the  injection.    The  results  of  the  different  and 
varied  experiments  of  Traube  and  Gscheidlen,  Fodor  and  Wyso- 
kowicz,  Schmidt  and  Grohman,  Nutall,  Nissen,  Buchner,  Hali- 
burton,  Hankin,  Stern  and  others,  bear  evidence  to  the  anti- 
septic 'and  germicidal  properties  of  the  blood,  and  even  that 
blood   after  being  drawn,  still  retains  those  properties,  for  a 
limited  time     Stern  found  that  the  blood  taken  from  different 
men,  or  from  the  same  man,  at  different  times,  varies,  mark- 
edly! in  its  germicidal  properties.    But,  not  only  has  it  been 
found  that  bacteria,  when  injected  into  the  blood,  rapidly  dis- 
appear from  the  circulation,  by  numerous  experiments  upon 
animals,  but  also  in  the  case  of  diseases  induced  by  microbes, 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc.  7 

that  during  the  period  at  which  the  disease  is  at  its  height,  the 
special  microbe  of  the  disease  becomes  numerous  in  the  blood 
of  the  patient  and  then  disappears  as  the  disease  abates. 

Dr.  Canon,  of  the  Moabit  Hospital,  found  in  his  investiga- 
tions of  the  recently  discovered  bacillus  of  influenza,  that  those 
special  bacilli  were  abundant  in  the  blood  during  the  fever  of 
influenza,  but  that  they  disappeared  with  the  disappearance  of 
the  fever.  And  the  same  thing  has  been  noted,  repeatedly,  of 
splenic  fever  and  of  other  bacterial  fevers. 

Wysokowicz  accounted  for  the  disappearance  of  the  bacteria 
from  the  circulation,  not  by  the  supposition  that  they  were 
destroyed  by  the  blood,  but  that  they  found  lodgment  in  the 
capillaries.  But  such  supposition,  I  think  not  reasonable,  as  an 
accumulation  of  bacteria  in  the  capillaries  would  be  obstruct- 
ive of  the  circulation  and  likely  to  produce  mischievous  results 
otherwise.  It  has  been  found  by  numerous  observers  that 
micro  organisms  of  different  species  and  in  varying  proportions 
in  different  subjects,  are  present  in  the  faeces,  and  I  think  the 
following  to  be  a  reasonable  account  of  the  manner  of  their  dis- 
appearance from  the  blood,  whether  introduced  by  artificial 
injections  or  absorbed  into  the  blood  from  the  developments  of 
bacteria  in  other  tissues  of  the  body. 

One  of  the  functions  of  the  blood  is  to  carry  all  effete,  useless 
or  hurtful  matters  to  the  glands  which  co-operate  in  the  elimina- 
tion, and  the  intruding  organisms  are  thus  consigned  to  the 
lymphatics,  which  terminate  in  the  lower  bowels,  with  the  excre- 
tive products  of  the  metabolic  processes  within  the  tissues,  and 
in  that  manner  become  a  part  of  the  faeces. 

The  supposition  that  the  bacterial  diseases  were  caused  by 
fermentation  of  the  blood,  prevailed  during  the  period  immedi- 
ately following  the  first  discovery  in  bacteriology,  viz:  that  fer- 
mentation is  the  result  of  the  working  of  microbes  in  the  sub- 
stance undergoing  the  process,  and  when  little  else  was  known 
concerning  micro-organisms;  but  as  further  discoveries  were  made 
that  supposition  was  discarded,  and  by  all  who  have  kept  them- 
selves acquainted  with  the  progress  of  this  modern  science  has 
now,  for  several  years,  been  relegated  among  the  errors  of  the 
past.  In  fact,  it  is  apparent  that  were  there  any  species  of 
microbes  possessed  of  the  power  to  effect  the  molecular  changes 
in  the  blood  involved  in  the  process  of  fermentation  their  intro- 
duction into  the  circulation  would  speedily  end  in  the  death  of 
the  subject  in  all  cases. 


8        Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 

But  no  such  organism  has,  as  yet,  developed;  on  the  contrary, 
even  those  microbes  which  attack  the  living  tissues,  and  which, 
as  might  be  supposed,  have  been  found  to  possess  a  greater 
degree  of  tolerance  of  the  sanguineous  conditions  than  other 
species  have  been  proved  by  observations  to,  in  a  measure,  lose 
their  activity  and  virulence  by  being  subjected  to  experiments 
by  which  they  were  exposed  to  the  germicidal  properties  of  the 
blood.    Grohmann  and  Schmidt  found  that  anthrax  bacilli, 
after  being  kept  in  coagulating  blood  plasma,  were  less  virulent, 
as  shown  by  their  effects  upon  rabbits.    Fodor  made  a  series  of 
experiments  with  blood  taken  from  the  heart,  which  showed  its 
marked  germicidal  properties  on  anthrax  bacilli  and  much  other 
experimentation  with  this,  one  of  the  most  virulent  species  of 
parasites,  exhibits  like  evidence  with  the  preceding.    It  is  true 
that  several  experimenters  have  succeeded  in  producing  syphilis 
by  inoculating  with  the  blood  of  a  subject  of  syphilis;  and  it  is 
probable  that  other  bacterial  diseases  can  be  reproduced,  or 
marked  effects  caused,  by  inoculating  with  the  blood  of  the 
subject  during  the  maximum  period  of  the  disease;  but  that  the 
microbes  remain  dormant  whilst  in  the  blood  and  are  unable  to 
develop  until  they  have  been  conveyed  to  conditions  of  shelter 
from  the  circulation,  is  sustained  by  all  observations  .and  evi- 
dence bearing  upon  the  subject;  whilst  the  view  of  the  fermen- 
tability  of  the  living  blood  could  be  sustained  only  by  the 
reversal  of  the  established  principles  of  physiology  and  in  con- 
tradiction to  the  pathological  observations  in  this  connection. 
But  the  condition  of  dormancy  of  these  organisms  and  retention 
of  vitality,  is  the  means  by  which  certain  of  the  species  are  dis- 
tributed, by  the  circulation,  to  their  respective  locations  of 
development;  which  in  the  case  of  syphilis,  however,  is  without 
much  choice  as  to  tissues  and  not,  necessarily,  but  little  shelter 
from  the  blood  current,  as  is  evidenced  in  the  advanced  stage  by 
its  general  prevalence  in  the  system  and,  in  some  cases,  by  its 
ravages  in  the  tissues  of  the  heart  and  lungs  and  even  in  the 
walls  of  the  blood  vessels. 

The  real  manner  of  the  incubation  of  syphilis  may  be  illus- 
trated by  the  more  observed  process  in  vaccination,  to  which  it 
is  similar.  In  vaccinating,  experience  has  shown  that  in  intro- 
ducing the  virus  the  chances  of  success  are  best  by  removing 
only  the  cuticle  without  drawing  blood;  and  in  the  usual  infec- 
tion of  syphilis  it  is  evident  that  the  infection  takes  place 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc.  9 


without  the  extrusion  of  blood;  neither  is  the  virus  absorbed 
into  the  blood  vessels  but  it  is  merely  withdrawn  from  the  im- 
mediate surface  by  the  limited  inter-cellular  circulation  of  the 
tissue  juices,  the  co-operative  accompaniment  of  the  nutritive 
changes  within  the  tissues,  and  the  subsequent  chancrous  devel- 
opment is  the  result  of  the  multiplication  of  the  microbes  in  the 
adjacent  tissues;  being  the  counterpart  of  the  process  which,  in 
vaccination,  forms  the  vesicle.  In  those  cases  of  syphilis,  in 
which  cauterization  or  excision  failed  to  reach  the  seat  of  infec- 
tion, or  in  which  no  chancre  appeared,  the  germs  have  been 
withdrawn  by  the  intercellular  circulation  beyond  the  reach  of 
ordinary  cauterization  or  a  shallow  excision,  and  the  primary 
colony  was  developed  so  far  within  the  tissues  as  to  escape 
observation. 

It  has  become  established  by  numerous  experiments,  that 
those  microbes  which  affect  the  animal  tissues,  but  which,  like 
the  true  scavenger  birds,  wait  until  life  has  become  extinct  be- 
fore entering  upon  their  work,  are  comparatively  innocuous; 
but  there  are  several  species  which  delight  in  conditions  of  im- 
paired vitality,  hovering  between  life  and  death,  as  it  were, 
which  infest  localities  where  pathological  conditions  are  present, 
waiting  for  opportunity  to  gain  entrance  to  the  body  of  some 
subject,  through  an  abrasion,  puncture  or  excised  surface,  and 
then  succeed  in  the  outcome  of  their  work,  very  much  in  pro- 
portion to  the  unsoundness  of  the  parts  entered  upon,  or  the 
general  loss  of  vitality  of  the  subject  attacked;  the  representa- 
tive species  of  which  are  pyaemia,  septicaemia,  gangrene  and 
erysipelas.  But  these  show  by  their  works  their  inability  to 
contest  the  germicidal  properties  of  sound  blood,  in  the  full 
strength  of  its  normal  constituents  and  circulation.  The 
bacillus  of  tubercle,  as  is  well-known,  progresses  in  its  des- 
truction of  tissue,  in  proportion  to  the  impairment  of  the  diges- 
tion, the  assimilative  process,  or  the  lack  of  proper  nourishment, 
and  is  held  in  abeyance  by  improved  conditions  in  these  respects. 

The  slow  working  but  persistent  bacillus  lepra  first  becomes 
established  in  its  subject,  through  conditions  of  squalor  and 
lack  of  suitable  nutriment.  Scurvy  is  developed  by  lack  of  a 
certain  class  of  food,  which  is  necessary  to  keep  the  blood  in  its 
normal  proportions;  and  the  principal  curative  treatment  con- 
sists in  supplying  the  required  diet,  to  restore  the  sanguineous 
fluid  to  the  condition  which  nature  prescribed.    But  enough  of 


10      Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 


these  matters  has  been  stated  to  illustrate  the  principle.  Water 
which  has  become  separated  from  the  ocean,  deprived  of  its 
antiseptic  protection  and  stands  in  swamps  and  pools,  may  be- 
come corrupted  and  fill  the  air  with  malarious  emanations;  but 
the  great  body  of  salt  water  remains  self  protected  against  the 
attack  of  the  all  pervading  micro-organic  life,  and  diffuses  its 
corrective  principles  into  the  atmosphere,  as  far  as  its  influence 
reaches;  and  somewhat  in  comparison  are  the  relations  of  the 
volume  of  the  blood  within  the  body.    When  by  reason  of 
occlusion  or  destruction  of  the  vessels,  other  tissues  are  deprived 
of  their  normal  blood  supply,  or  the  blood  itself  is  lacking  in 
its  normal  protective  constituents,  the  pathogenic  specie  s  may 
attack  the  parts  left  defenseless,  or  the  devitalized  system,  with 
success;  but  in  the  vital  fluid  itself,  whilst  the  life  remains,  the 
most  malignant  species   are  unable  to  effect  the  molecular 
changes,  which  would  cause  its  disintegration;  and  whilst  the 
blood  continues  in  its  integrity,  with  its  full  power  of  protective 
constituents  and  with  free  circulation,  the  tissues  are  fully  pro- 
tected against  all  but  a  few  of  the  more  virulent  of  the  species, 
and  those  are  obliged  to  do  their  work  under  conditions  of 
shelter  from  the  currents  of  the  circulation.    The  blood  diseases, 
as  so  long  popularly  called,  are  not  blood  diseases,  in  the  cor- 
rect meaning  of  the  term,  but  are  diseased  conditions  of  other 
tissues;  the  devitalization  and  other  morbid  manifestations 
being  due  to  the  absorption,  into  the  blood,  of  the  results  of 
the  molecular  changes  wrought  by  malignant  micro-organisms, 
in  the  affected  tissues.    Formerly  the  products  of  the  pro- 
cesses of  these  organisms  were  all  included  under  the  name 
of  ptomaines;  but  as  investigation  has  advanced,  these  pro- 
ducts have  been  found  to  possess  different  characteristics,  and 
hence  other  names  have  been  applied  to  designate  the  different 
products.    The  latest  work  on  bacterial  poisons,  is  entitled, 
"Ptomaines,  Leucomaines  and  Bacterial  Proteids,"  recently 
published  by  Lea  Brothers  &  Co. ;  the  work  of  Victor  C.  Vaughn, 
Ph.  D.,  M.  D.,  and  Frederick  G.  Novy,  Sc.  D.,  M.  D.,  both  of 
the  faculty  of  the  University  of  Michigan.    This  late  work 
states  that,  ' '  a  number  of  bacterial  poisons  have  been  obtained 
from  the  bodies  of  men  and  the  lower  animals;"  and  that,  "  we 
now  expect  to  find  each  specific  micro-organism  producing  its 
characteristic  poison  or  poisons."    Of  the  non-malignant  species, 
those  used  for  effecting  chemical  changes,  interesting  discov- 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc.  11 


eries  have  also  been  made,  in  regard  to  their  products  varying, 
according  to  the  medium  or  substances  which  they  are  furnished 
to  work  in. 

The  processes  and  results  of  the  pathogenic  bacteria,  in  the 
tissues,  very  well  explain  the  causes  of  the  extraordinary  waste 
and  devitalization  in  the,  properly  so  called,  wasting  diseases; 
and  the  pathology,  in  connection,  and  physiology,  show  the 
reasons  why  the  blood  is,  necessarily,  the  principal  medium  by 
which  remedies  are  applied,  in  such  diseases;  and  why  stim- 
ulants, tonics,  sedatives,  nutrients  and  anti-sepsis  are  required, 
according  to  the  special  conditions  of  each  case.  And  in  some 
chronic  conditions,  the  permanent  entrenchment  of  certain  non- 
tissue  working  species,  within  the  digestive  organs,  waiting  to 
enter  into  the  ingested  food,  after  each  meal,  and  which  by  their 
appropriation,  undergoes  changes,  detrimental  to  the  assimila- 
tion of  the  subject;  and  the  poisonous  products  of  the  pathogenic 
species  in  their  destructive  work  in  the  tissues,  with  the  great 
variety  of  their  chemical  characteristics,  and  of  which  more  or 
less  must  be  absorbed  into  the  bloo  d  of  the  subject,  thereby, 
as  we  may  suppose,  affecting  to  a  greater  or  less  extent,  the 
chemical  constituents  of  the  secreted  food  solvents,  exhibit  to 
us,  why  the  therapeutics  of  nutrition  are  often  more  intricate, 
in  chronic  conditions,  than  the  medical  therapy,  and  will  con- 
tinue to  be  so,  until  investigation  and  observations  have  re- 
vealed much  that  is  now  hidden. 

There  have  been  some  curious  results  attained  by  acting  upon 
suggestions,  furnished  by  the  success  of  vaccination.  In  the 
first  instance,  by  Pasteur  in  his  treatment  of  rabies,  which  has 
been,  to  an  extent,  a  success.  In  the  second  instance  the  at- 
tempts to  stay  the  ravages  of  anthrax ,  by  inoculation  with  its 
attenuated  virus,  which  has  never  gone  into  general  practice. 
The  third,  the  attempt  to  stay  the  progress  of  yellow  fever,  by 
a  similar  process;  and  the  latest,  the  numerous  experiments 
with  the  Koch  lymph,  the  failure  of  which  to  meet  the  public 
expectations,  was  all  the  more  notable,  from  the  former  suc- 
cesses and  the  reputation  of  its  originator. 

Were  cow  pox  a  modified  form  of  small  pox,  as  has  been 
claimed  by  some  writers,  there  might  be  more  warrant,  in  the 
example  of  vaccination  for  the  process  of  inoculation,  with  at- 
tenuated virus,  in  other  diseases;  but  the  history  of  one  hun- 
dred years  practice  of  vaccination,  exhibits  no  tendency  of 


12      Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 


vaccina  to  verge  into  variola;  but  on  the  contrary,  the  protec- 
tive disease  has  remained  constant  to  its  original  charcteristics, 
in  the  mildness  of  its  course,  and  in  its  own  peculiar  manifesta- 
tion; and  the  history  of  the  experiments  of  inoculation,  in  other 
diseases,  adds  to  the  evidence,  that  there  has  been  no  instance, 
as  yet,  developed  of  a  parallel  of  the  relations  of  any  other 
diseases  to  each  other,  as  that  which  exists  between  vaccina  and 
variola;  for  even  the  limited  success  of  Pasteur,  in  the  treatment 
of  rabies,  has  only  been  achieved  throughfa  complicated,  tedi- 
ous process,  evolved  by  along  series  of  experimentation,  under 
Pasteur's  own  patient  and  skillful  manipulation;  and  having 
formed  a  system  which  yielded  results  to  justify  the  application 
in  practice,  has  been  carried  out  only  in  institutes,  specially 
established,  with  extensive  adjuncts  and  appliances,  and  in  the 
charge  of  men,  specially  trained  for  the  work.    Had  as  simple 
a  system  been  adopted  for  rabies,  as  that  of  vaccination  against 
small  pox,  the  inaugurator  of  the  practice  would  have  been  re- 
warded with  imprisonment,  instead  of  French  francs  and  popu- 
lar reputation.    The  fact  is,  that  no  real  similarity  has  ever  been 
proven  to  exist  between  small  pox  and  cow  pox,  except  in  that 
they  are  both  self  limiting  and  one  attack,  usually,  gives  immu 
nity  against  future  attack;  the  circumstance  that  vaccination  is 
protective  against  variola,  being  attributed  to  the  coincidence, 
that  the  microbes  of  the  two  diseases  both  require  the  same 
peculiar  principle  of  pabulum,  in  order  to  develop;  the  self  li- 
mitation being  dependent  upon  the  exhaustion,  in  the  subject, 
of  that  certain  principle;  and  as  vaccina  exhausts  the  said  prin- 
ciple, without  causing  dangerous  sickness,  it  is  much  the  safer 
disease  to  have  and,  therefore,  a  beneficent  protection,  as 
against  the  other. 
In  my  report  to  this  society  for  1885,  I  mentioned  the  Chinese 
/  method  of  disposing  of  the  detritus  of  their  cities,  as  related  by 
f  Dr.  Williams,  in  his  work  entitled  "  The  Middle  Kingdom." 
Those  people  cannot  be  considered  as  advanced  in  their  sanitary 
arrangements,  in  most  respects,  but  in  this  particular,  their 
simple  management,  in  my  opinion,  is  very  much  superior  to 
the  complicated  and  expensive  systems,  in  use  by  the  cities  of 
Europe  and  America.    Desiring  to  obtain  more  detailed  infor- 
mation in  regard  to  this  matter,  I  interviewed  an  intelligent 
Cantonese,  by  the  name  of  De  Wing,  at  present  interpreter  for 
the  law  courts,  at  San  Jose,  and,  from  him,  obtained  the  follow- 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc.  13 


ing.    The  city  of  Canton,  containing  a  million  and  a  half  of  in- 
habitants, has  no  sewerage,  the  offal  and  faecal  accumulations 
being  carried  off,  from  day  to  day,  by  a  force  of  from  five  to  six 
hundred  men.    Quite  early  in  the  morning,  these  men  go  to  the 
houses  of  the  citizens,  each  with  two  large  wooden  buckets, 
which  are  filled  with  the  accumulations  of  the  previous  twenty- 
four  hours.    The  contents  of  each  pair  of  buckets  weigh  about 
one  hundred  and  twenty  pounds,  and  this  load  each  man  car- 
ries to  the  river  landing,  and  thence  conveys,  with  a  small  boat, 
to  the  farming  lands  of  the  neighborhood ;  where  it  is  applied  to 
fertilize  the  soil,  in  the  cultivation  of  rice,  Irish  potatoes,  sweet 
potatoes,  cucumbers,  garlics,  melons  and  other  products  for  the 
city  markets.    The  farmers  make  contracts,  in  advance,  with  the 
collectors  and  carriers  for  the  fertilizer,  for  a  certain  length  of 
time,  and  pay  them  for  the  delivery,  a  stipulated  price.    This  is 
a  wise  and  beneficent  arrangement  for  the  parties  immediately 
concerned  and  for  the  entire  population;  as  by  it,  the  people  of 
the  city  are  rid  of  their  detritus,  without  any  expense  to  them- 
selves, and  so  promptly,  that  there  is  no  time  for  putrefaction  to 
set  in  or  disease  germs  to  develop;  in  corroboration  of  which 
Dr.  Williams  states  that  typhus,  typhoid,  scarlet  fever  and 
diphtheria  are  not  included  in  the  list  of  the  prevalent  diseases 
of  China.    And  the  farmers  are  compensated  for  their  disburse- 
ments, in  the  increased  product  of  their  lands,  the  laborers  ob- 
tain their  living  by  the  employment,  and  the  city  and  surround- 
ing country  are  able  to  sustain  their  population,  by  this  means; 
whereas,  were  these,  so  called,  waste  products  destroyed,  as  is 
now  done  in  a  great  part  of  the  world,  starvation  and,  more  or 
less,  depopulation  would,  necessarily,  come  to  pass.    In  the 
populous  province  of  Canton,  corresponding  to  one  of  our 
states,  there  are  seventy-two  cities,  including  Canton,  and  no 
sewerage  in  any  of  them,  the  detritus  of  the  other  cities  being 
disposed  of  in  a  similar  manner,  as  at  Canton,  except  that  at 
the  inland  towns,  the  containing  buckets  are  carried  by  the  la- 
borers on  foot,  the  entire  distance,  to  the  suburban  farms  and 
gardens.    As  to  whether  the  cities  of  China,  other  than  those 
of  the  province  of  Canton,  have  sewerage  or  not,  De  Wing  could 
not  positively  state,  but  his  impression  was  that  there  is  no 
sewerage  in  the  Chinese  Empire,  and  as  the  work  of  Dr.  Williams 
referred  to  the  Chinese  method,  of  disposing  of  the  detritus,  in 
a  manner  to  indicate  that  it  is  the  general  practice,  it  is  likely 


14      Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 

that  De  Wing's  impression  was  correct,  and  that  this  same  sys- 
tem of  husbanding  the  resources  is  carried  out  throughout  the 
Empire.  And  it  would  appear,  that  the  important  matter  has 
never  assumed  the  proportions  of  a  complicated  problem,  in 
China,  which  has  been  puzzling  the  brains,  during  the  later 
centuries,  of  legislators,  city  rulers  and  scientific  engineers, 
throughout  the  more  modern  civilization,  and  has  been,  more  or 
less,  a  constant  burden  to  the  tax  payers  of  all  modern  muni- 
cipalities; and  yet  the  best  systems,  developed  by  all  this  brain 
work,  skill  and  money  outlay,  result  in  only  an  imperfect  sani- 
tation, the  retarded  contents  of  water  closets,  cess  pools  and 
sewers,  being  immense  cultures,  in  which  breed  the  deadly  mi- 
crobes of  diphtheria,  typhoid  fever  and  other  infectious  dis- 
eases. Then,  from  an  economic  stand  point,  the  sewerage 
system  is  an  immense,  unnecessary  and  unjustifiable  waste  of 
what  was  intended  should,  in  a  measure,  re-place  the  drain 
upon  the  soil  by  the  annual  tribute,  exacted  in  the  cropping, 
for  the  sustenance  of  the  earth's  population.  Vast  regions  of 
Asia,  which,  in  ancient  times,  sustained  the  most  dense  popula- 
tion, and  constituted  the  most  civilized  portions  of  the  globe, 
have  been  practically  destroyed;  turned  into  barren  wastes  by 
improvident  husbandry;  and  whilst  there  is  some  excuse  for  the 
populations  which  existed  in  those  early  times,  there  is  much 
less  excuse  for  such  management  at  this  advanced  period.  Not 
alone  in  Asia,  where  millions  are  annually  exposed  to  the  lia- 
bility of  starvation,  through  the  improvidence  of  the  past  na- 
tions, the  preceding  occupants  of  the  lands,  is  there  want  and 
misery  from  lack  of  food;  but  throughout  almost  all  of  Europe 
there  is  nearly  perpetual  pinching  and  hunger,  among  the 
poorer  classes;  and  in  this  year  of  uncommon  scarcity,  gaunt 
famine  pervades  great  districts  of  an  Empire  which  has,  usually, 
exported  large  quantities  of  bread  stuffs;  and  the  food  supply 
has  become  a  question  of,  more  or  less,  uncertainty,  in  most  of 
the  countries  of  that  continent;  and  especially,  in  the  hitherto 
favored  island,  which  has,  in  a  measure,  dominated  the  world's 
commerce  and  held  great  international  influence,  her  rulers  and 
legislators  now  find  their  most  difficult  and  serious  problem,  to 
be,  that,  of  devising  the  ways  to  enable  her  laboring  classes  to 
earn  the  food  to  appease  their  stomachs;  to  obtain  in  a  moder- 
ate measure,  the  comforts  of  life  and  to  produce  the  wherewith, 
which  will  be  accepted  in  compensation  for  the  vast  quantities 


Supplemental  Report  on  State  Medicine,  Hygiene,  Etc.  15 

of  the  cereals,  animal  and  other  foods,  which  she  is  annually 
obliged  to  import,  as  contributory  to  the  subsistence  of  her 
population.  If  the  wise  statesmen  of  this  modern  nation  would 
take  a  lesson  from  the  management  of  the  economic  ancient 
nation  of  the  Orient,  in  this  regard,  they  would  be  able,  in  part, 
at  least,  to  solve  their  food  problem;  and  that  in  a  happy  and 
beneficent  manner  for  her  agricultural  husbandry,  the  welfare 
of  her  working  people,  and  the  sanitary  betterment  of  the  condi- 
tion of  her  cities;  and  particularly,  in  the  relief  for  the  suburban 
river  districts  of  the  metropolis,  now  subject  to  nuisance  from 
the  discharge  of  the  sewage  of  the  great  city,  into  the  tide-waters 
of  her  harbor. 

The  Chinese  system  of  immediate  collection  and  transporta- 
tion to  the  fields,  of  city  detritus,  would  be  more  economical  and 
superior,  from  a  sanitary  standpoint,  to  the  system  of  sewage 
irrigation,  now  in  use  by  the  cities  of  Paris,  Berlin  and  many 
other  cities  on  the  continent  and  in  Great  Britain;  and  it  is  high 
time  that  a  stop  should  be  put  to  the  waste  of  this  most  valuable 
fertilizer  throughout  Europe,  and  the  more  economic  plan 
adopted.  As  to  America,  with  its  comparatively  virgin  soil,  and 
less  dense  population,  an  excess  is  raised,  as  yet,  for  annual 
exportation,  to  supply  the  deficiencies  of  other  nations ;  but 
unless  the  inhabitants  of  the  New  World  will  take  heed  from 
the  lessons  of  deterioration  and  impoverishment,  brought  upon 
their  lands  by  the  carelessness  and  mismanagement  of  the  older 
countries,  history  will  surely  repeat  itself,  in  that  respect,  on 
this  continent. 

As  to  the  collecting  and  transportation,  with  the  appliances 
which  could  now  be  made  available,  of  movable  vessels,  with 
impervious  lining,  two  for  each  water  closet,  each  one  to  be 
used  alternately,  and  the  one  containing  the  previous  day's 
accumulation,  to  be  placed  on  retiring,  where  it  would  be 
accessible  to  the  night  workmen,  outside  of  the  locked  apart- 
ments; with  street  car  tracks  of  the  same  gauge  as  the  steam  car 
roads  and  suitable  tanks,  to  be  used  on  the  cars  and  on  trucks, 
where  there  were  no  car  tracks;  hoisting  works  for  handling  the 
tanks,  and  the  proper  arrangements  for  readily  and  easily  clean- 
ing the  emptied  tanks  and  vessels,  as  used,  the  whole  collection 
could  be  made  nightly,  during  six  or  seven  of  the  hours  of 
retirement.  The  cost  of  the  plant  would  not  be  more,  if  as 
much,  as  that  of .  the  average  sewerage  system ;  and  as  to  the 


16      Supplemental  Report  on  State  Medicine,  Hygiene,  Etc. 

working  expenses,  they  would  consist  largely  of  the  disburse- 
ments to  the  laborers  employed.  The  use,  as  a  fertilizer,  would 
not  be  limited  to  the  immediate  vicinity  of  the  cities,  as  with 
railroad  facilities,  it  would  bear  transportation  for  considerable 
distances  into  the  country;  and  as  soon  as  the  farmers  had 
learned  its  value  and  become  accustomed  to  its  application,  the 
sales  of  this  theretofore  accounted  waste  product,  would  entirely 
compensate  for  all  the  expenses  of  collecting  and  transportation. 


